A Qualitative Exploration of Various Stigmas Impacting HIV Pre-Exposure Prophylaxis (PrEP) Uptake Among African American Young Adults

Abstract

Pre-exposure prophylaxis (PrEP) has promise for reducing racial/ethnic HIV disparities; yet, acceptance among African Americans remains low. PrEP-related stigmas may impact uptake, but this is understudied. This study examines mechanisms by which stigma impacts PrEP acceptance among various priority African American populations. Focus group data from 63 African American young adults (aged 18-29 years) in Louisville, Kentucky, explore how various stigmas impact attitudes toward PrEP. Data were analyzed using grounded theory analytic techniques. PrEP stigma, HIV stigma, sexual behavior stigma, and homophobia/transphobia individually reduce PrEP uptake. These stigmas also interact synergistically to undermine PrEP acceptance. Key challenges resulting from various stigmas and their interactions include medical hesitancy, lack of perceived susceptibility based on gender and sexuality, the role of gender norms in HIV prevention, and deprioritizing HIV prevention due to social rejection. Interventions to increase awareness, destigmatize PrEP, remediate social marginalization related to identity, HIV status, and gendered perceptions of sexual risk, as well as more focus on diverse priority groups, are needed to present PrEP as a viable HIV prevention option for African American communities. More research is needed to optimize strategies that address stigma and increase acceptance of novel HIV prevention technologies.

Differences Between General Internal Medicine and Family Medicine Physicians’ Initiation of Pre-Exposure Prophylaxis

“…22 Qualitative research has revealed that stigma around HIV, stigma related to PrEP and sexual behavior, and homophobia/transphobia each contribute to less PrEP utilization. 24 We observed that anxiety disorders were associated with a 72% greater odds of receiving PrEP and this is similar to the 67% increased likelihood of starting PrEP among those with an anxiety disorder in a nationally distributed medical record data base. 13 Although others have found no association between anxiety and willingness to start PrEP, 25 we have now shown a positive association between anxiety disorder and PrEP receipt in a national cohort and a multi-state health care system.…”

“… 22 Qualitative research has revealed that stigma around HIV, stigma related to PrEP and sexual behavior, and homophobia/transphobia each contribute to less PrEP utilization. 24 …”

A conceptual analysis of SBIRT implementation alongside the continuum of PrEP awareness: domains of fit and feasibility

“…According to CDC reports, there are several overarching challenges in HIV prevention, including issues related to awareness, treatment, equitable access to information, limited resources, stigma, complacency, and poverty (10). Studies on the challenges of PrEP awareness, initiation, and adherence highlight multiple factors, including stigma, medical mistrust, substance misuse, inequitable access and promotion, and high costs (11)(12)(13)(14)(15)(16)(17). Research examining what hinders an individual's movement along the PrEP Care Continuum has identified inadequate knowledge regarding how PrEP works, failure to translate PrEP's potential benefit to persons at higher risk of contracting HIV, and inaccurate information about PrEP limiting its initiation among populations experiencing disproportionate risk (18)(19)(20).…”

PrEP-related stigma and PrEP use among gay, bisexual and other men who have sex with men in Ontario and British Columbia, Canada

“…Some individuals may avoid seeking or staying on PrEP as a consequence of anticipated or experienced stigmatization [14]. Furthermore, stigma overlaps with HIVrelated stigma, in a way that fear of HIV may decrease PrEP uptake as it prevents individuals from openly talking about HIV [24]; similarly, it overlaps with homophobia, which is important because individuals might decline PrEP or stop using it because they may not want to be associated with a particular sexual orientation [24].…”